Kaisu.txt
To preserve this information, I have copied
it into text here:
http://www.kaisuviikari.com/about_me.htm
This book is by Kaisu Viikari M.D., Ph.D.
It is strongly supportive of myopia preventive measures,
with strong emphasis on the use of the plus.
The fact that she supports the "plus", is indeed why
we should call here (and all other medical people
who support the concept), second-opinion doctors.
Enjoy,
Otis
======================
Kaisu's book:
Summary:
Preface
My Dogmata
My Statements
Books:
jotta totuus ei unohtuisi 2004
Panacea 1978
Tetralogia 1972
Studies of the Cholinesterase ... 1955
Miscellaneous Feedback Links About me
======================
Preface:
Professor of Pedagogy, Kari Uusikylä on Aamu TV broadcast on
22 April 2008:
You cannot create something without being sufficiently
independent and bold.
”The only way to make progress in medicine is to act in
different way from what textbooks and current practice recommend”
(A Savage Enquiry – Who controls Childbirth; Wendy Savage, Jane
Leighton. Virgo 1986)
First of all I would like to emphasize that my books are not
paramedical nor alternative medicine as they have sometimes
dismissively been branded, but sound science that is fully based
on physiological facts.
The greatest obstacle to the message of my books getting
through is its simplicity.
A GLANCE TOWARDS THE PAST
Before perusing the theme I will be dealing with, we should
take a short trip back in history to realize that myopia is not
about an ordinary development trend. It is unlikely that any
other consequence of evolution, if this is what we can call it,
has come about as fast as myopisation. We only have to remember
how valuable a myopic slave was in ancient Greece, as a rare
person who preserved his ability to read and do near work far
longer than the majority of the population. Spectacles were only
invented some 700 years ago.
PANACEA!
It was an outright stroke of genius, a heureka, to find
PANACEA, or "a remedy for all ills" as the name for my book, the
message of which is about plus glasses as a general remedy; in
addition, the name has a lofty connection to the history of
ancient Greece, as the name of the daughter of the god of
medicine, Aesculapius.
Ophthalmology is a field that has during the last
semicentennial made advances comparable with any achievements, but
at the same time, the cornerstones of our profession have been
miserably neglected. This is despite the fact that Sir Duke-Elder
(1899-1978), the guru of us ophthalmologists, has already said
everything essential about the central role of the eyes in our
lives in the Preface of his book, The Practice of Refraction. "…
of all the ailments which interfere with the smooth running of the
human machine, eye-strain in one form or another is one of the
most common."
The great masses, billions of people suffer the consequences
of negligence in reducing accommodation strain, and the society
pays an enormous price for this negligence.
It has been my life's work to focus on attempting to remedy
this situation.
Today, the world is so completely stagnated to routine
thinking that totally new viewpoints are hardly ever put forward.
Without real and genuine open-mindedness, there is no point
even starting to read my website.
The many "dogmata" I will present have even to me become
clear gradually, over decades.
%%%%%%%%%%%%%%%%%
Dogmata
“It is better to be roughly right than precisely wrong”
John Maynard Keynes
In order to perform a successful examination, the
ophthalmologist him/herself must be relaxed.
Only practical applications will validate theoretical
achievements (Panacea p. 424).
There is no medicine to beat plus glasses!
The best proof that a diagnosis and treatment are correct is
the disappearance of symptoms.
Hyperopia never lies, in other words at least the quantity
that has been revealed is real.
What is the sign of a latent hyperopia? Quite frequently,
excellent long distance vision!
A citation that I have adopted as my own: "Myopia is a
'violation' of seeing".
It often only is a significant enough inborn hyperopia that
saves one from slipping to the minus side.
The body never lies; it displays symptoms.
Many types of definitions are apt to make our logic clearer.
^^^^^^^^^^^^^^^^^^^
My Statements:
my statements Contents:
Accommodation Hyperopia
Emmetropization (process attempting to reach normal refraction of
the eye) Presbyopia, or Old Age Vision Myopia (nearsightedness)
Pseudomyopia (PsM) Spasm of Accommodation The Fogging Method
Prevention of Myopia Complications of Myopia Accommodative
Astigmatism Anisometropia, refractive difference between two eyes
Strabismus (squint) Migraine The Autonomic Nervous System On the
Examination and Treatment of Eye Patients A Word About Refraction
Surgery About Science Light And The Eyes
ACCOMMODATION Asp.
The whole physiology of the eye is centred around
accommodation. Accommodation refers to the ability of the eye to
focus at different distances, in order for a living organism to
cope with the necessary tasks. It is one of the most inimitable
and ingenious fine mechanisms of the nature.
Focusing takes place through changing the form of the
crystalline lens which means changing the refraction power of the
lens. The lens is attached to the eyeball and the accommodation
muscle, corpus ciliaris, with a series of noncellular extensions
(Zonula Zinnii), which originate in the ciliary muscle and insert
to the capsule of the lens. There is a certain paradox associated
with this mechanism. When m. ciliaris contracts, these fibres
relax and the lens due to its elasticity becomes rounded,
increasing its refraction power. To understand this mechanism it
is essential to be familiar with the macroscopic structure of the
m. ciliaris. On the inside of this muscle, there are small
processes, processus ciliares, to which the fibres are inserted;
when the muscle is working, it contracts, pulling the processes
towards the lens (this phenomenon has been described as "lifting
up the skirts of a crinoline") and the fibres automatically relax.
Accommodation is an interesting series of psycho-physical
occurrences. This action of the accommodation muscle represents
clear-cut muscular work, continuous and as such a totally
comparable to and as strenuous as any other muscular effort. This
is why the muscles may, similarly to other muscles (writer's
cramp, the cramp in an athlete's calf) experience a cramp, or a
spasm of accommodation (Asp). The clear nature of accommodation
as muscular work is also associated with the fact that women as
the "weaker vessels" far more frequently than men are afflicted by
many clinical ailments, such as migraine (in Tetralogia, this
proportion is 3 to 1; in Panacea, less than one out of five
patients were men in the material of 1,558).
Accommodation is a dual function, that comprises both a
positive and a negative component;
a) the so-called positive accommodation, referring to the
focusing achieved by contraction of the accommodative muscle
regulated by the autonomic parasympathetic nerve. In the
regulation of positive accommodation, there are two basic events:
a partial regulation, which means the rough approaching of the
object looked at; the person only aims his or her gaze in a
general direction (the sea, the woods) and a second or “fine”
regulation which leads to the actual focusing, on a detail (a
boat, a tree) (Mütze K: Die Akkommodation des Menschlichen Auges.
Berlin 1956)
b) the so-called negative accommodation, or desaccommodation,
regulated by the autonomic sympathetic nerve may also be an active
process (brought about by central control), and it means the
relaxation of accommodation, in turn regulated by the sympathetic
nerve.
This is a concept of which the layman – and often also
physician – rarely hears, even though both occurrences are of
central importance as to their physiological consequences. It can
be produced either by looking into infinity or by fogging (i.e.
looking through strong plus glasses).
As accommodation is reflected to our entire organism,
reducing the strain caused by it is an invaluable panacea, a
veritable general cure, with the irreplaceable nature that no
foreign substance needs to be brought into the organism!
HYPEROPIA (farsightedness)
Majority of human beings are born hyperopic by approx. 2.5
dioptres, meaning that the eyeball is too short. In a manner of
speaking, the eye is defective, but this involves a certain
purpose of the nature. If our eyes were myopic from the
beginning, we could not manage such tasks as hunting, (as the lens
is incapable of reducing its refractive power from its original
thickness), which was vitally important at a time.
Without the effort of the accommodation muscle, not even a
hyperopic eye could see accurately to the distance. Correcting
this deficiency through accommodation results in a great stumbling
block, as vision experienced as normal hides latent hyperopia.
This latent hyperopia often remains uncorrected and the patient
without treatment. We must remember that a young, healthy person
does not generally suffer from headaches without a reason, and
headaches often are the cause of visiting an ophthalmologist!
Prerequisites for revealing latent hyperopia often is great
strain of strong hyperopic eye in focussed seeing or a weakened
general condition (illness, menstruation). As we age, our ability
to accommodate will deteriorate, resulting in the need for reading
glasses in the middle age (40 ± 5 years). I have often been
concerned to see a pile of books on a patient's bedside table, but
no sign of glasses! "Forgetting" to take your reading glasses off
is a good sign of the need for plus glasses for distance!
In this connection, we absolutely must also mention as causes
for hyperopia being latent, the clinically central importance of
glaucoma medicines, which constrict the pupil, first and foremost
the universally used pilocarpine, a circumstance that to my notice
has not been highlighted anywhere else (Tetralogia p. 144,
Panacea 367-8). The vision sharpened by the small pinhole sized
pupil so spoils the patient that he resists all need for glasses
("....for a small pupil a large error is necessary to produce a
given amount of blur.", Toates:Vision Res. 1970:10:1069-76.), and
yet it is precisely the relief of plus glasses that would
alleviate his problem, or the increased intraocular pressure. I
would urge those who wish to gain insights in this and make it a
permanent asset for themselves to read the relevant paragraphs in
my books.
a) A hypermetropic eye: parallel rays of light come to focus
behind the retina
b) A hypermetropic eye: parallel rays of light are brought
to a focus upon the retina by increasing the refractivity by
accommodation.
c) Rays of light coming from near demand the lens to become
even thicker .
EMMETROPIZATION (process attempting to reach normal
refraction of the eye)
The development of inborn hyperopia results in
emmetropization, the struggle of the eye towards normal refraction
of ± 0, which usually takes place by the age of 6 -7 years.
The primus motor in this development is accommodation, which
stretches the eyeball by the movements of m. ciliaris (the fibres
reaching far inside the eyeball). An excellent illustration of
this mechanism is given by Norman L Adel in his work
(Electromyographic and entoptic studies suggesting a theory of the
ciliary muscle in accommodation for near and its influence on the
development of myopia. Am J Optom 1966;43:27.). In this work, he
describes how the "stellated" muscle fibres, which resemble
narrowing and widening diamond shapes, stretch the surface layers
of the eyeball. The still elastic eyeball of a young person is
essential in this development. This leads to the axial
lengthening of the eyeball, or myopia.
Only a great enough inborn hyperopia is able to save the
emmetropization of gliding over the zero pont, to the minus side!
How often we hear even professionals talk about emmetropes,
supposedly people with normal refraction, when in fact a real
emmetrope is a great rarity!
PRESBYOPIA, or OLD AGE VISION
Presbyopia also is a phenomenon closely associated with
accommodation, presbys meaning "old person".
The lens becomes less flexible and accommodation is gradually
lost.
In the middle age of 40 ± 5 years, this action starts getting
less flexible, and near work becomes more difficult and becomes
tougher. This is the latest hour for finding relief in plus
glasses.
"Socializing glasses"
It is hardly very unusual that, when sitting around a table
in a party late in the evening, you start feeling like yawning.
The distance to those you are socializing with is often short,
almost the same as a long reading distance. Personally, I have a
slightly stronger pair of glasses (in plus direction) for this
purpose, "socializing glasses", and I have recommended these to
many others.
MYOPIA (nearsightedness)
MYOPISATION
What else would myopia be than emmetropization, which has
ended up exceeding the zero point provoked by long-term
accommodation!
Life tends to make us tense, this is something we all know;
but relaxing and keeping it in check is much more difficult. It
requires conscious resistance and guidance. Tragically, in
today's society near work begins at an early age, with children
under the school age, not the least with various types of games
and more than anything with the computer. The emmetropization
begins early, and the slide towards the minus side even earlier.
It is usual for increasingly young children to complain of the
deterioration of distant vision, requesting minus glasses of their
ophthalmologist.
a) A real, axial myopia (elongation of the axis of the eye).
b) A pseudomyopic eye. The situation in a spasm of
accommodation: the lens of an emmetropic or hypermetropic eye
fixed in its swollen state, in a spasm of accommodation (provoked
by close work); the eye still has additional power of
accommodation. Light rays coming from infinity (broken line) are
refracted to a point in front of the retina. Correction with
minus lenses leads to a vicious circle of myopia.
c) In order to control the situation and release the spasm of
accommodation the need for accommodation is suppressed by placing
a plus lens in front of the eye. To begin with the reading
distance will drop, but will lengthen again as the spasm is
released. At the same time, distant vision without glasses begins
to improve.
PSEUDOMYOPIA (PsM)
PsM is the preliminary phase of myopia, still reversible lens
myopia as distinguished from true axial myopia (lengthening of the
eyeball). Minus glasses that have not changed for years already
arouse a strong suspicion of pseudomyopia. The person is at his
or her extreme of accommodation.
SPASM OF ACCOMMODATION
The first adequate description of an accommodation spasm
(Asp) dates back to von Graefe (1856) and Liebreich (1861), in
which connection the term spurious or pseudomyopia was used.
A spasm of accommodation is a fatigue cramp in an overworked
ciliary muscle caused by insufficient opportunity to relax
(Panacea p.88, Ermüdung und Müdigkeit, Documenta Geigy, 1967). It
is fully comparable to cramps in other muscles, such as the
writer's cramp. I have even met a young male patient who had
cramps in the muscles of his buttocks.
An accommodation spasm can exceed the dioptric refraction
power of the eye by 25 or even 30 D
An Asp (spasm of accommodation) is usually easy to diagnose.
Too often, however, it is missed, and pseudomyopia is optically
corrected with minus glasses. (Duke-Elder, System of
Ophthalmology, Vol.V, 1970, Kimpton, London).
One of the grossest errors an ophthalmologist can make is not
mastering the pseudomyopia of a presbyope, as warned by Milder
(Benjamin Milder, Melvin L Rubin: The Fine Art of PRESCRIBING
GLASSES, Without Making A Spectacle of Yourself. Triad Scientific
Publishers, Gainesville, Florida, 1978, s.4). This is to avoid
situations such as a 47-year old patient, who has been using +1.0
reading glasses and comes to the ophthalmologist because she is no
longer able to read, being told that her glasses are still
adequate.
The relatively common belief that myopia will be cured in
presbyopia illustrates the commonness of PsM; that is when Asp
automatically begins to relax.
When dealing with the refraction error of the eye, a smart
optician may be a safer choice than a less smart ophthalmologist.
This should not, however, be mixed up with a visit to the
ophthalmologists, as many aspects remain unexamined.
Stress is absolutely a factor provoking Asp, and stress is
maintained by such as pressures of studying and rush. I am bold
enough to declare that the most universal type of stress that
concerns everyone is precisely accommodation strain.
Very convincing proof of this is provided by the study
conducted with cadets who started at the US War Academy, West
Point, in 1935 (Gmelin, Robert T. Myopia at West Point: past and
present. Milit Med 1976:141: 542-543.) This study found an
almost linear increase in myopia in each year of attending the
school. The earliest article paying attention to myopia dates
back to 1813. (Ware,J. Observations relative to the near and
distant sight of different persons. Phil.Trans.Roy.Soc., Part
I:31-50, 1813. and Derby, H., Influence on the Refractions of
four year College Life, 1873-1879. Trans Amer.Ophthal.Soc.,1879.)
PsM = Asp, but Asp is however not synonymous with PsM, as Asp
also occurs in the range of hyperopia. Latent hyperopia means
nothing but a more or less tight contraction in the muscle of
accommodation.
THE FOGGING METHOD
The cornerstone for the work of an ophthalmologist and
optometrist is in-depth knowledge and understanding of the
accommodation event. Revealing latent hyperopia as well as
pseudomyopia will always be the yardstick for the quality of work
of these professionals.
A prerequisite for being successful is mastering the fogging
method, which is the aim of my books Tetralogia and Panacea. The
fogging method has been known and also used through the ages, but
in such an ineffective form.
I have developed this method further into a ”polyphasic
fogging method”, which will not let the examiner down. If one
trick will not work, e.g. the relaxation will not progress, we
must resort to another, as there are innumerable variations. Each
one of the different methods is accurately described, and no
detail is unnecessary. This is something you have to just believe
and accept, if you wish to achieve mastery. Experience will then
bring so much illumination to the matter, that over the years the
examination will become less cumbersome.
Those interested in my method can read all about it in my
works. I will only mention a few central issues: One must
understand that with fogging, one aims at voluntary, knowing
prevention of the phase of adjustment, thus also preventing the
exact focussing which provokes the spasm of accommodation. In
this, 1-2-3 dioptres will be no help, and the fogging needs to be
strong enough to, for a start, make the distinguishing of even the
biggest details impossible. There is no upper limit for the
dioptres! One should also all the time ensure that the patients
blinks as little as possible, as blinking also maintains
accommodation tension. You often see the stream of tears starting
just at the end of the blinking, and this is when the relaxation
of accommodation takes place.
The examination is always started binocularly, with both eyes
fogged and the patient not being allowed even to glance at the
vision acuity test chart in beforehand. At the end you can test
the acuity separately for both eyes, which the patient usually
always is interested in, with whatsoever glasses, but this will
not be the basis for any prescription for glasses.
We must remember that continuing merely with fogging may
result in the opposite effect; stretching or relaxing of a smooth
muscle as such provokes a contractions (Guyton. Textbook of
Medical Physiology, 1964, s.256.W.B. Saunders Company.
Philadelphia and London) This is why the "unsuspecting, virgin"
answers at the beginning are important in the fogging method.
Confirmation test or flipper test
One of the most efficient ways of getting results with
fogging is the confirmation test, the name of the instrument
below.
I have several of these as ± 0,25, ± 0.5, ± 0,75, ± 2,0(which
enables fogging of 4 dioptres instantly), and also custom made
flipper cylinders ±0.5 as a direct and on the other side ±0.25 as
an indirect cylinder.
As much as I have advised my colleagues to purchase them,
only few have done it.
In general when prescribing glasses, we should not strive for
excessive acuity (which the whole world of optic business is
toting in the advertising), as this is precisely what will destroy
the whole treatment. The patient usually finds relief for his
ailments not in focussing his vision but in alleviating the
accommodation strain. This is almost another dogma. Vision
acuity of 1.0 is therapeutically adequate. The best is the enemy
of the good, even in this case.
The fogging method is also known by another name: CYCLODAMIA
This is a non-cycloplegic (binocular) method of refraction
employing a fogging technique for relaxing accommodation,
especially one based on an excessive amount of convex sphere and
not drugs inhibiting accommodation. This is how we can determine
acuity reduction gradients, from which the refractive error can be
estimated by extrapolation. In other words, this is the
conventional fogging method under a different name.
PREVENTION OF MYOPIA
After these elementary concepts of ophthalmology, we will
move on to the wide-ranging and challenging field of myopia and
pseudomyopia prevention.
To sum up, myopia is a condition where the eyeball already
has been subjected to stretching, it has become axially elongated
and the state is irreversible, whereas pseudomyopia means Asp,
lens myopia, which can still be reversed.
Even if most of the means for preventing myopia have been
known for a hundred years, the results remain non-existent.
THE GREATEST OBSTACLE FOR THE SUCCESS OF PREVENTION HAS BEEN
THE BELIEF THAT MYOPIA IS HEREDITARY.
The most important means of prevention is getting plus
glasses (+3.0) for near work as early as possible. This, however,
has received less attention, as this point has been highlighted in
the current form for no more than the last few decades.
We must keep an eye on children's reading distances, which
many parents fortunately do understand, but if you watch a class
of schoolchildren on television, for example, at least every one
small child out of two draws or does sums with his nose stuck to
the paper! This no longer is a case of reading glasses of even +3
d being enough! In this precise situation, the reading glasses
will force relaxation of the accommodation tension and increase
the distance. Teachers have more than enough work here, and I
dare say this should take first place in priorities.
Looking too close is a bad habit, by no means a necessity.
If the child will not learn to keep his working distance long
enough, the primary method is to teach him to regularly support
his chin with his hand at a forearm's distance from the desk. The
children also quite commonly seem to have the habit of lying on
their tummies in front of the television, which is not at all to
be recommended, as the viewing distance often is very short.
The most superior trick is to rest the accommodation by
looking "dreamily" far away, and lifting the gaze from the page
without focusing e.g. after every passage. This piece of advice
is just as important for children and adults. The need for a good
working light is self-evident, even though poor light alone is not
the crucial cause in the development of myopia, unlike often
suspected by laymen.
In China, where they are ahead of us in so many things,
children are taught to massage the acupressure points around their
eyes in order to prevent myopia, surely a tradition based on
experience. This is quite right, as these are the points where
the nervus trigeminus comes out, and this nerve plays a central
role also in accommodation (Panacea pp. 192-3). fig. 3.
This Chinese poster tells how massaging and pressing the
correct acupuncture points around the eyes can cure myopia.
Night myopia is the result from an effort to see better at
low levels of lights, such as twilight or at night. The dark
period in the autumn is the ophthalmologist's nightmare. The
darkness draws people being near to emmetropy to an accommodation
tightness, and this makes it even more difficult to fight against
adding the minus strengths, and their reduction being met with
great resistance.
In those who already are myopic there is all reason to find
measures that would prevent the deterioration of the situation.
They include:
Nobody at any age should ever be allowed to read with
distance minus glasses; however, there is nothing to stop you from
using undercorrected minus glasses at a distance. One should have
at least two pairs of minus glasses, the weaker one to be put on
as soon as one gets home, in case it is not possible to abandon
the glasses altogether at home. One should also attempt to manage
driving in the daytime with the weaker glasses, with the stronger
pair kept for night time driving. We should watch television from
as a long a distance as possible, staying as near as needed but
always attempting to move the chair a little bit farther.
Monofocal minus glasses should not even exist, and consequently Up
till -3.0 - -4.0 dioptres, the lower section of the glasses should
either be empty ( = half glass, which is the cheapest of bifocals)
or the lower section should be a ±0 =, a so called plano lens).
Outside these values should be used bifocal combinations with the
appropriate dioptric values. In a situation where a plus
half-glass only is indicated, which one so often sees people
wearing (these should also be worn constantly), the frame must be
open at the top; “a boom” at the top in the middle of the field of
vision does nothing but harm.
Even in other contexts, the reader must understand that the
guidelines given here are rough generalizations, allowing
applications demanded by the case and conditions.
However, such as progressive glasses, which so often are
almost pushed on the customers, are the detriment of all
treatment. Firstly, astigmatic distortions cannot be avoided with
these; the stronger the glasses, the more disturbing they will be.
Another great disadvantage that the user is not usually aware of
is that when the strongest part of the spectacles is only met in a
gradual manner in the lower section, its effectiveness often
remains completely outside the viewing area.
Bifocals should be of the so-called Executive lens type, with
a straight border as high as possible. This type is the most
attractive and least noticeable, if this should be particularly
important for anyone. Of course there are other fully acceptable
lenses with large lower sections, but in these the border is often
seen as “claws”, a less attractive line.
A good alternative for progressive lenses is trifocals, also
in the Executive type; but these will only be needed by persons of
a slightly more advanced age.
The wearing of minus glasses is no obligation, unlike the
plus glasses, without which nobody should be. But people are so
strange: you could be pleading with a myopic not to wear glasses
(which would be quite possible for many), but they refuse point
blank! Whereas hyperopics, no matter how much you plead with them
to wear their glasses, would like to put them aside. How often
have I aired my standard remark, when waiting for a patient to dig
out their glasses, that they are in the wrong place. My
often-repeated guideline concerning plus glasses is "from the
bedside table to the bedside table!" and those who have adhered
with it have found that it gives them strength.
The current enthusiasm about collecting second-hand glasses
for the developing countries frightens me. A very great number of
these are minus glasses of the wrong type. When people in those
countries with no appropriate expertise try on the minus glasses
and feel that they make the world "brighter", they become
enamoured with them, and so an impetus has been given to the
progress of evil – but the business will flourish! To get an idea
of the fanatic dependence on their glasses of myopics, I would
recommend reading case 306 in Tetralogia and case 306 in Panacea.
COMPLICATIONS OF MYOPIA
All I have discussed above would not be so startling, if
myopia did cause not only plenty of clinical suffering but also
evil that cannot be reversed. How many people could not work in
their dream profession because they were myopic. How many eyes
were blinded by detachment of the retina (ablatio retinae) caused
by the stretching of the eyeball, even in very young people! In
these cases, too, operative results have improved over the years,
but the losses are still great. Myopia makes you vulnerable to
degeneration of the retina, and many people have had they eyesight
affected by this problem. Vitreous degeneration and glaucoma due
to myopia are also common.
ACCOMMODATIVE ASTIGMATISM
Accommodative astigmatism is another entity that requires a
lot of attention. When monitoring my patients, it seems to
display an increasing trend and ever changing axes, the whims of
which should not be followed without question. I am personally no
stranger to these pitfalls, either.
My conclusion is that it is worth attempting to reduce and
level out all these quantities and to straighten the axes, as they
are to a great extent provoked by accommodation strain and often
at least to some degree reversible and non-permanent
(pseudoastigmatism).
Reinforced cylinders could indeed increase the acuity of
vision, but hardly the comfort of seeing.
Like marionettes, the whole world of optometrics has in its
sophisticated wisdom ended up implementing and fixating these
measurement readings, creating stepping stones towards ever
stronger distortions. What we need is a tremendous simplification
of attitudes, a real over-simplification, a basic intuition of a
whole new type. This will mean a great deal of wearing of plus
glasses, or glasses altered in the plus direction, and we must
emphasise, pushing them on people.
We must bear in mind the whole time that a patient usually
willingly accepts glasses in the minus direction and will not
complain, as they do not feel their eyesight has got any worse!
ANISOMETROPIA, REFRACTIVE DIFFERENCE BETWEEN THE TWO EYES
Dominance is also relevant to eyes, in other words one eye
dominates the other. In the very same way as some people jump
with the right foot and others write with their left hand, one eye
of a person often is dominant, or stronger.
The stronger eye is capable of more forceful accommodation,
and ends up being more tense. This is the start for
anisometropia, or refractive difference between the eyes.
This can be established by an examination, but if this type
of difference, which usually is minor to begin with, is taken into
consideration in a prescription, an opportunity is simultaneously
created for making this difference larger. This is why it is
fully justified, initially anyway, to proceed with equally strong
glasses, as a person who has up till now been looking through
"equal" lenses will not find this type of glasses disturbing even
now.
Another consequence associated with dominance is squint.
STRABISMUS (SQUINT)
In multiform and multi-etiological strabismus cases,
hyperopia often is one of the etiological factors. When a great
need for accommodation and convergence strain (turning inward of
eyes) become imbalanced, this may easily result in an inward
squint (strabismus convergens), in a symmetrical, monolateral or
alternating form, or if the person has not enough strength for the
continuous convergence and he gives up, an outward squint
(strabismus divergens) is the result, either alternating or
monolateral.
It would seem that a monolateral squint could well be
explained by the dominance of the eyes.
Let us presume that a child is strongly hyperopic for a
start. He is forced to accommodate more than usual when trying to
see accurately, even when looking at a distance, to say nothing
about near vision. In this situation, the dominant eye may easily
end up with a more tense muscular spasm, converge more (look
inwards more steeply) and turn inwards unsymmetrically. What we
find here is a periodical or permanent, monolateral inward squint,
strabismus covergens, on the side of the dominating eye. Or the
person does not have the strength for adequate convergence. What
happens is that the "weaker" eye cannot match the effort and gives
up, does not converge but gives in and turns outwards, resulting
in an outward squint, strabismus divergens (turning outwards of
sight lines), on the side of the eye that is more strongly
hyperopic.
All these states would require early intervention =
alleviation of the accommodation strain = plus glasses. This is
why I have half in jest quipped in my book, "that the truth should
not be forgotten", that preferably we should all be born with plus
glasses on! At the latest when the child starts doing near work
(in addition to a number of other issues that must be considered)
he should get plus glasses (+3.0; if there is distance hyperopia,
this +3.0 should be added to the distance correction, as
bifocals).
It is not difficult to find plenty of support in the
literature for everything I have discussed above. To only mention
a few examples, President of the International Myopia Prevention
Association, USA Donald S. Rehm, an engineer who since the
beginning of the 1970's has been speaking for the same cause.
I recently spotted a work on the Internet, according to which
”…process of emmetropisation, appears to have been impeded by the
consistent wearing of hypermetropic spectacle correction from the
age of 6 months.” (Emmetropisation squint, and reduced visual
acuity after treatment. R.M.Ingram, P.E.Arnold, S.Dally, J.Lucas.
BRITISH Journal of Ophthalmology 1991:75:414-416).
MIGRAINE
Migraine is one of the main themes of my books. Migraine is
a chaos in the autonomic nervous system. As positive
accommodation irritates the parasympathetic and negative
accommodation the sympathetic nervous system, the disruption in
the balance of these functions results in a chaos which extremely
frequently is the fundamental cause of migraine.
In an article, Friedman mentions that ophthalmologists have
found correction of refractive error to result in considerable
improvement in 90% of migraine patients treated.(Friedman AP:
Treatment of migraine. N Engl J Med 1954:250;600-2) . It is a
good idea to remember in this connection that a migraine is not
always associated with a headache. And on the other hand,
reckless and continuous consumption of analgesics may fuel a
chronic headache or migraine.
I have discussed migraine in such great detail in my books
that I will not repeat it all here. I would also like to remind
my readers of the fact that migraines and epileptic fits have a
lot in common, and this is why we should think of minimizing the
accommodation stress in epilepsy patients as well. An epileptic
fit often occurs e.g. when the patient is watching television.
THE AUTONOMIC NERVOUS SYSTEM
A demonstrative observation
The inseparable connection between accommodation and the
autonomic nervous system, which is behind all display symptoms,
became clear to me at a very early stage, of which I will never
cease to be grateful. Very likely, this was the impetus that
determined the orientation of my whole life's work. As I was
working on my thesis, I had to drop substances irritating the
parasympathetic nervous system (including pilocarpine) in the eye
of a rabbit, after which the rabbit almost instantaneously had
diarrhoea; in other words, a parasympathetic peristaltic reaction
of the bowel caused by a small amount of a substance.
Using atropine to inhibit a spasm in m. ciliaris and reveal
latent hyperopia is one of the first things that students of the
field come across, especially with children. Already at this
stage students using their brains should understand what an
important factor accommodation is in the general reactions of the
body. These examination drops often cause many types of
generalised symptoms, arrhythmia, rise of temperature, and
restlessness amounting to disorientation, so that the parents
downright begin to panic. It is my understanding that these
symptoms are in proportion to the degree of hyperopia revealed.
It is also interesting that as the increase of pluses
stimulates the sympathetic nervous system, its effects are
comparable to e.g. the use of amphetamine. This is why it is
possible that the patient can even become addicted to plus
increases and provoke the ophthalmologist to unnecessarily great
increases in the pluses. This kind of a situation naturally is
very rare, but it is good to be aware of this possibility, too.
An important ganglion, ganglion ciliare, is located behind
the eyeball. Despite its small size of a few millimeters, it is
one of the most central ganglions in our bodies, from which extend
wide-reaching connections like branches of a tree. The attached
illustrates the way neural pathways from here travel like reins
both to the brain and spinal nerves and the autonomic nervous
system.
When the whole nervous system is entwined in it, mastering
this issue requires not only an in-depth understanding of not only
the accommodation event but also anatomy and physiology as well as
a multidisciplinary, integrating interest.
In other words, symptoms may appear not only in the autonomic
nervous system but at many levels. (The facial nerve may become
paralysed when a feverish patient recovering from the flu is
watching television without plus glasses); more than anything
through the fifth N(ervus) Trigeminus and spinal nerves everywhere
(Difficulty of straightening the back after strenuous near work;
many back pains appear to be caused by muscular spasms, the spasm
originating reflexly from pain impulses elsewhere in the body.
Guyton, 1964, p.661).
ON THE EXAMINATION AND TREATMENT OF EYE PATIENTS
There is no-one whom spectacles would not concern at least in
some stage of life (this was the title of my interview for Turun
Sanomat newspaper in 1973).
A stressed organ will become ill We should remember this when
treating such as iritis, in which inhibiting accommodation strain
is essential. The eye is made to rest by means of both atropine
(drops inhibiting accommodation) and also mydriatics (drops
widening the pupil). It is also important to assure that the
healthy eye can rest by means of sufficient plus correction (or
with an addition to plus direction).
The faces of the patients as such already reveal a lot to an
expert.
Frequent blinking, by which the patient without knowing it
supports the maintenance of accommodation tension is disturbing.
Winking or tightening of the whole muscle group around the eye is
a sign of the same (Putin when trying to cope with his text
without glasses) A young child frowning in a convergence test
Small pupils and in a blue-eyed person, eyes of a peculiar blue
colour = the iris stretched out wider Permanent vertical lines in
the forehead (up to 5-6 cm in length), that almost serve as a
dioptric gauge! The muscles that cause these are referred to as
accessory muscles of accommodation (above all m. corrugator
supercilii) Slightly swollen, "heavy" eyelids, even in a child, or
upper lid that is straight in its shape are tell-tale signs of
accommodation strain. A tick (live blood), myocymia, (twitching
or vibratory movements of individual muscle bundles following
fatigue, clonic blepharospasmus in the eyelid) almost certainly is
crying for a plus increase. I mention all these terms for the
symptom, as patients generally are interested in it because it is
highly annoying. The cause is fatigue in the muscles surrounding
the eye innervated by the cranial nerve VII, n. facialis. Often
just unwillingness to read, even skiving off school, stomach pains
and restless sleep are symptoms of the same thing. Small bruises
of blood under the conjunctiva, sugillatio subconjunctivalis, may
tell the tale of a plus deficiency. Wobbling or tense wings of
the nose (alae nasi) are a further sign of accommodation strain.
Narrowing the eyes into an extremely small gap between the lids,
(“pig eyes”) by which the person achieves a so-called stenopaic
disk , a pinhole, through which it is possible to see clearly
(excellent example is J. V.) And what about a chin that is hard
as stone, which I have observed when trying to change the position
of the patient's head! How often I have emphasized the fact that
a restful expression and peaceful demeanour, are the most
pleasant, and this could be achieved with spectacles alleviating
accommodation.
A good way of showing to a person wearing minus glasses how
great an accommodation strain he is maintaining the whole time:
give him a text to hold. He will often read it from a
significantly short distance. You whisk away his glasses, and the
distance stays the same! In other words, they are constantly
exposed to an overload to the extent of the power of their
glasses.
Whereas when you give small print for a presbyopic to read,
he immediately pulls further away. This is already a sign of a
great defect.
The patient ombudsman might say: "wrong type of glasses"...
These do not exist, as there is no absolute truth in refraction
values. It would be wise to say e.g. that the examination has
revealed a refractive power value that in the relaxation of the
ciliary muscle achieved would correspond to a hyperopia of +3.5.
And thus we have glasses that are closest to the correct values,
or at the discretion of the ophthalmologist, a prescription for
"therapeutic" glasses.
Further, there is no absolutely correct refraction value, but
whoever has shown the greatest degree of hyperopia is always
closest to the truth.
This is why the strongest plus value obtained is not always
indicated for the patient, but the initial situation determines
the rate of progress that follows the patient reaction. Quite
often it is necessary, however, also to resort to "pushing" and
many types of leading strategies, as no progress can be made with
a tense patient by just "hushing".
The tolerance of aged people is usually more limited, and it
is a good idea to watch out for changes in the glasses that are
too great.
We are learning and progressing all the time, but there is
one thing that we will never learn to estimate for sure: how
great a plus increase the patient will tolerate a) immediately b)
in the longer run. What is crucial is "previous conditioning" and
sensible progress.
Even a young patient may need to be hospitalised for heart
tests because of arrhythmia caused by sympathetic irritation due
to too sudden a release of accommodation (Stina Häggblom).
My greatest joys achieved through this type of therapy have
been seeing a patient (who used to wear strong minus glasses)
getting rid of suicidal tendencies.
"Getting wise" on all these phenomena is by no means simple.
Rather large changes in dioptric strengths are required to show
the causal relationships. It equally requires years of experience
and long-term follow-up of the same patients to get an idea of it.
We must start by believing and following this experience as
described by others.
At least a reasonable store of glasses to lend to patients is
necessary to get the patient started, as very few people are
prepared to make the financial sacrifices that relatively fast
changes of glasses require in the beginning. I had about 300
pairs of spectacles provided by me and the patients after they had
experienced the benefits of this procedure. When talking with the
doctor, the patient promises to come to the surgery "even with a
paper bag over his head", if that is what it takes to make
progress, but often this remains just a promise in practice.
“Red rags” for me:
This is only about glasses! "As good an eyesight as
possible" This is why it is unfathomable and downright
unforgivable that pain clinics and migraine treatment teams do not
feature a single ophthalmologist, but that of course is their own
fault. The doctor is often heard to pronounce: "This symptom has
nothing whatsoever to do with eyes", which is one of the most
stupid statements, after the patient often has quite correctly
suspected a connection. Similarly, it is unforgivable to say that
one must learn to live with one's headache, just because the
doctor is unable to help!
Disrupted sleeping patterns, burnout and depression
When I think of all the concern that is at the moment felt in
the world over the increasing lack of sleep of the working
population and the associated sick leaves due to burnout and
depression, it is hard to witness the fact that this essential
additional factor in burnout, accommodation stress, does not begin
to receive the attention it deserves.
When writing a prescription for glasses, it is a good idea to
always check the interpupillary distance, often even in the
beginning and end of the examination; this difference may be a
couple of millimetres, depending on the tension in the patient.
If the patient is constantly lifting up his chin even when
reading with bifocals, this is a sign that the border definitively
is too low; if the patient lifts his chin when talking, the higher
section is considerably lacking in plus correction.
n + 1 examiners often means n + 1 different prescriptions!
“How to avoid making a spectacle of myself!” (reference:
subtitle in Milder´s book)
A WORD ABOUT REFRACTION SURGERY
I will not even stoop to discuss the immorality of the
flourishing and ever increasing refraction surgery, which
mutilates healthy eyes. Many types of surgical complications are
always possible, and even one lost eye is a catastrophe.
Thankfully, there are some honest eye surgeons who, before
consenting to perform the procedure, make sure that the patient is
clear about such as the nuisance of being dazzled, which is quite
common when driving at night.
Download a PDF article on refractive surgery news: Ocular
Surgery News-OSN Meeting News,March 2008, page 14
Also in Ocular Surgery News,March 2008, page 12: Dr. Bucci
said he relies on what he terms his "three core questions" to
distinguish between patients who merely want their cataracts
removed and those who do not yet have cataracts but who are
seeking spectacle independence and might be candidates for
presbyopia-correcting IOLs. The questions include asking patients
if they have interest in achieving spectacle independence, if they
would be willing to tolerate some light phenomena while driving at
night to achieve this and if they would be willing to pay out of
pocket for it.
ABOUT SCIENCE
How often you hear people enthusing about scientific
evidence! We have seen the results this has achieved. Hundreds
and again hundreds of myopia and myopia prevention congresses have
been about nothing but exchanging statistics, without a single bit
of progress. This is self-deception, because accommodation strain
cannot be translated into formulae, as there are too many
variables involved in the examination. We must use a much more
simple approach as well as common sense, and the results will be
rewarding. Quantitative and scientifically exact measurement of
accommodation strain is simply impossible! It can perhaps partly
be illustrated by the following demonstrative test.
Professor Meesmann examined the refraction of the eye using a
cat's eye (Experimentelle Untersuchungen über die antagonistische
Innervation der Ciliarmuskulatur). Albert von Graefe´s Arch
Ophthalmol 1952;152:335-355.
Refraction of the eye sciascopically (retinoscopic, mirror
reflection examination) without drops was – 0.5 D. By stimulating
the sympaticus nerves of the neck (which inhibit accommodation)
hyperopia went up by 4 – 6 D. When cranial nerve III, N.
oculomotorius, which takes care of active, positive accommodation,
was dissected another 3 D of hyperopia was revealed. If at that
stage, in lack of antagonistic forces, the neck sympaticus nerve
was further stimulated, the total hyper-opia went up to 10 D.
But, if even the sympaticus nerve was dissected the eye refraction
settled back at the original - 0.5 D.
It is not for nothing that Duke-Elder already on the cover of
his book on refraction (1969) emphasizes: ”It remains a simple
and essentially non-mathematical presentation of basic principles
of the theory and practice of correcting defects in the optical
system of the eyes and their associated muscles. Clinical rather
than theoretical, it is a thoroughly practical book.” It is worth
reading! However ”…the book comes nowhere near the truly
non-mathematical viewpoint represented in the present
work.”(Panacea p. 9)
LIGHT AND THE EYES
Completely aside my main theme, refraction and myopia, when
talking about eyes I cannot desist from bringing up a study that
in its message and power of evidence has been one of the most
inspiring in my life (not only because I have been fortunate
enough to personally meet the author), but which, however, I feel
has over the years received too little attention. This work was
written by the Hungarian Professor of Ophthalmology Magda Radnot
in year 1953, Die Wirkung der Belichtung der Augen auf die
Funktion der Gonaden, (The effect of light on gonads,
Ophthalmologica 1953;127:422-4).
“By nocturnal periodic illumination of the eye of the duck, a
growth of the testicles and sperminogenese was provoked in the
drake and a functioning of the ovary and oviduct in the female so
that eggs were laid.”, with demonstrative photos – so much as
about light and eyes is otherwise discussed!
++++++++++++++++++++++++
Panacea
PANACEA (1978) "DAUGHTER" of TETRALOGIA The Clinical
Significance of Ocular Accommodation
Download the entire book as a PDF (English, 506 pages)
INTRODUCTION
Oculists find themselves in the same dilemma as doctors in
general: when young they lack experience. Thus a doctor who has
himself often been ill is generally a good doctor and best
understands the perils of taking several drugs at the same time.
A young oculist inevitably has little experience of the nuances
involved in prescribing glasses and has even less experience of
the burden of hypermetropic, knows nothing of the awkwardness of
presbyopia with advancing years and cannot know how hard it is for
those who suffer from both hypermetropic and presbyopia to do
close work. Even a presbyotic oculist often rejects the use of
glasses in the manner of a layman. How then can he help his
tormented patient when diagnosis of his latent trouble requires at
least that the oculist understand what is going on? Thus the
oculist himself, often without intending it, makes light of
hypermetropia.
Even today a great deal of "traditional knowledge" is picked
up from one's elders in the course of training - and it is hard to
know whether this is good or bad - but one thing is certain, the
really important things about refraction are sadly neglected. One
sometimes wonders why capital so dearly bought should remain in
pawn. One pre-supposes that a doctor who is specializing will
already have a talent for unearthing such everyday things, but
what I am trying to say is that there are a vast number of things
which cannot be learnt from books and which require years of
experience, even with the same patients, before they become clear.
You cannot really follow how the refraction of a particular
patient changes when working in an out-patients' department and in
any case three or four years' specializing is only a drop in the
ocean when it comes to learning how to prescribe glasses.
Those who have worked only a few months in a clinic easily
think that they know more or less what is involved in this field,
at least where something basic like refraction is concerned! One
does not have to be a genius in order to prescribe spectacles for
those who seem to need them. This is well illustrated by the
remark of a young fellow who did not find the prescribing of
glasses very interesting. "What the hell does it matter whether a
patient's glasses are half a diopter in one direction or another?"
Why not indeed, provided that it does not bring further problems
in its train and that incorrect spectacles do not lead to a
lengthy history of suffering as has so often been the case.
Prudence and true learning only begin when one's own mistakes
begin to boomerang and no comfort can be had from the thought that
lack of time was the cause, for hurriedness and prescribing of
spectacles are unsatisfactory bed-fellows. One of my colleagues
once observed that in prescribing glasses one must begin by
assuming that everybody else, — often the previous oculist — has
been an absolute idiot. The only trouble is, however, that one is
often the idiot oneself. I confess that the most difficult thing
of all is to face up to one's own mistakes, but here too love of
truth will help.
There is no need to worry about our mistakes if we have the
strength to admit them (La Rochefoucauld).
Just as every man must go through a certain process of
biological development, so must a man grow up to his profession \
thus one generation advances little upon the previous one, energy
is squandered on the same old mistakes which could so easily be
avoided. It is for this reason that I have here collected
together the experiences gained during twenty years of practice.
One may have to see a lot of life before one realizes how
important a good basic training is. I cannot boast of my
pre-medical learning, but I understand now how important each
branch is, especially, I think, anatomy (that of nervous system),
pharmacology and physiology. I am therefore all the more
horrified by all kinds of crash courses and short-cuts in
present-day medical training. One must have at least so much
basic knowledge that one can make intelli¬gent use of books when
dealing with problematic cases and in addition plenty of common
sense if one is to go forward wisely. The most efficient brains
are impotent if they are used for appropriating "accepted ideas"
blindly and if they lack the true scientific spirit and more
especially if they hold key positions.
At least in Finland, the fact is that most oculists are
private practitioners and it has been estimated that the
prescribing of spectacles comprises between 80% and 95% of their
work. The present book is therefore based on refraction,which is
intimately connected with diseases like migraine, increase of
intraocular pressure,many troubles accepted as actual eye
diseases, and probably other troubles like high blood-pressure.
Simple though the theme may be, it is of such great importance
that no (see also foot note l,p.344.) oculist can study It too
much and one must pity the oculists In hospitals who either have
not mastered refraction or underestimate Its seriousness.
When the question I am dealing with Is taken Into account the
oculists' work that Is left over Is really very restricted, at
least quantitatively, although of course It has Its problems.
Even the work of a run-of-the-mill oculist Is so heavy and
time-consuming that he Is seldom able to view any patient's
troubles In perspective, but once the matter Is understood, It Is
extraordinary to discover what a conspicuous part Is played by the
eyes and especially accommodation stress In a whole group of
different symptom-complexes and how crucial the decisions that
have to be taken may be for the patient. I believe the practical
applications of neuro-ophthalmology to be almost unlimited.
It may seem Incredible that such a wide medical field is
covered by a simple-seeming thing like latent hypermetropia and
spasm of accommodation.
We shall perhaps understand it better if we stand back a bit
and look at it from a distance. It may then dawn on us that the
workings of the human body have in recent times become subjected
to many unwonted strains, affecting particularly the eyes. The
eye, both because of its proximity to the brain and on account of
its function as a transmitter of that indescribably important
sensory stimulus - light - is neurologically at the centre of the
stage.
For this reason, the thesis here propounded, if acted upon,
will mean that patients with certain symptom-complexes are dealt
with by other hands and given a different kind of basic
examination.
I have tried to ignore the objections made to my work - we
all come in for our share of obloquy - and to draw strength from
those of my patients who have returned to give thanks for the
inalterable advice which has enabled them to persist in wearing
glasses when It seemed that all was lost and thus to succeed in
overcoming their troubles In the only way possible. We have all
met patients who have traipsed from doctor to doctor over the
years on account of severe headaches and have been overjoyed to
hear that after wearing the glasses we have prescribed they "never
'ad a day's illness since". And how such experiences comfort one
and confirm one in one's convictions !
"Put your glasses on the bedside-table when going to bed and
put them on as soon as you get up in the morning"^ I should like
this sentence to ring in the ears of head¬ache sufferers ! "You
must come back again and again if the trouble goes on; your
glasses may have to be modified. Headaches are not normal, as
some people seem to think ! Your head shouldn't be aching!"
Ethically I cannot allow my patients' heads to ache and especially
I can't bear the thought that they may be taking headache pills.
A patient taking pills for headaches is the oculist's nightmare
and no oculist should be content with a 25 % recovery rate (Sandoz
Report 3/1972).
If there is no brain tumour or other proven organic defect an
oculist should have no peace of soul until every headache has been
cured. As I often say to patients I am ashamed to see them
wearing nothing but dark glasses - the sign of a bad oculist.
Tinted glasses merely cover up mistakes and enable them to endure
the wrong spectacles.
As I have said,it is all the same to me, but not to society
as a whole, whether people can cope with their lives or not,
provided they are happy and fit to work, their heads are not
aching and their eyes are not troubling them. It is all the same
to me if they do not mind looking strained and old, if they do not
mind having high blood pressure and high intra-ocular pressure,
both of which endanger vision and can in extreme cases lead to
blindness. However, as soon as somebody comes to me for help, I
feel my responsibility and am in no way ashamed of my
over-enthusiasm in the attempt to reach the goal. I always say to
any patient I catch being disobedient that I will not see him
again because he is just wasting my time. There are plenty who
can be helped and who wish to be helped. Patients who will not
wear the glasses prescribed for them, run incurable, from doctor
to doctor, giving a totally misleading picture of the matter.
My book is intended to demonstrate how essential the
prescribing of proper glasses can be and how important their use
is for almost everything, and not just for the eyes.
In writing the book I have tried to shut out Mark Twain's
aphorism from my mind: " The less I know about a subject, the
more confident I feel and the more I illustrate it."
I am under no illusion that in this world of "received
ideas", where thought is paralysed, any great change will be
wrought at a single blow. I remain optimistic, however, for I
have seen the fruit of much more modest labour after a lapse of
only six or seven years. The one thing that is certain is that if
one does not even try to change opinion there is no hope that it
will change on its own and the written word has the advantage over
the spoken that it can bide its time !
I am fully aware that many and even contemptuous criticisms
have been raised, that there are some who see only fourth-rate
didactic fiction in everything, but even if the seed never grows I
have been able to write and express myself.
***************************
Tetralogia (1972)
Download the entire book as a PDF (Finnish, 238 pages)
Summary
This book of 230 pages including 723 case reports from the
author's own practice deals with the most crucial role held by
hypermetropia in ophthalmology and general diseases as well. Thus
the book is composed of a tetralogy: hypermetropia, one or two
vertical furrows on the forehead as the consequence of that,
migraine and elevated ocular pressure, all of which appear as a
sketch on the cover of the book.
A description containing 49 pages of a scrupulous and
far-detailed method for testing refraction is presented. The
essential principle is a binocular and very much blurred
initiation of the visual examination, by which method latent
hypermetropia can be detected far more effectively and more
completely than by cycloplegia which has often proved rather
defective. The superioritY,of the procedure described is made
apparent by demonstrating the contingency of erroneaus diagnoses
of "myopia", astigmatism, an isometropia, migraine and glaucoma if
the method is not mastered. The importance of keeping to
spherical lenses of equal effectivity as a guarantee for satisfied
patients cannot be overemphasized in this connection. The
furthest progressed "myopes" are found in the group that has
either learnt to read at a very early age or got their negative
lenses young. The chapter on pseudomyopia includes theories of
the ethiology, complications and prophylaxis of "school-myopia".
A table of migraine potients has been drawn up on the basis
of 174 cases, all of which being either pronounced hypermetropes
or pseudomyopes. Two separate tables are made of certain
particular cases picked up from among the total migraine material.
One presents 25 cases with drastic neurological symptoms even
epilepsy and quadrant-anopsia, the other consisting of 14 migraine
cases with typical refractional etiology, examined or treated
neurologically, but with negative outcome.
The essential role of hypermetropia in all cases of elevated
intraocular pressure (excluding secondary glaucomas after
inflammation or trauma) is demonstrated by a table of 60 glaucoma
cases. Tables showing pseudoexfoliation and cataract findings
have been given as these seem to be regularly associated with
hypermetropia.
A theory of hypermetropia as an etiological factor in
arterial hypertension is suggested on the basis of 84 cases. In
addition to marked hypermetropia lack or inadequacy of lenses
often to a very high age is characteristic of these cases.
The author suggests the old term "cataracta in oculo
glaucomatoso" to be substituted by or used parallelly with the new
diagnostic term "hypertensio et cataracta (et/seu
Pseudoexfoliatio) in oculo hyperopioso".
The book terminates in dreams of future objectives of
research and practical activity; it also presents a collection of
quoted aphorisms concerning the unfettering power of errors which
leads to fresh prospects, offer new alternatives and stimulates
continuous criticism.
link to Review of Tetralogia
%%%%%%%%%%%%%%%%%%%%%%%
Miscellanious:
Articles:
ABOUT THE CURRENT CULTURE OF SPECTACLES
TO SPECTACLE WEARERS AND EYE PATIENTS
PUPILLI LEHDEN ARTIKKELISARJA AKKOMODAATIOSTA 1988, pdf
(Pupilli Magazine articles about accommodation, in Finnish) lataa:
OSA IV OSA V OSA VI
MYOPIA AT WESTPOINT - Past and Present (PDF)
ABOUT THE CURRENT CULTURE OF SPECTACLES
What on earth has caused this regression in the last few
decades – not only in Finland but even further out – that has been
the downfall of the spectacles culture, which already was looking
rather good! Vast quantities of people are seen nibbling at their
frames and sucking their temples, predominantly consisting of VIP
persons, generally men.
Everyone afflicted by presbyopia, or old age vision,
completely regardless of what they started with, should in the
name of their own health constantly wear bifocals (or
alternatively multifocals, the optics and benefits of which are
however not ideal, or for more aged persons trifocals) at the very
least when they are giving a presentation or attending a meeting,
perusing documents. Wearing bifocal or multifocal glasses also
eliminates the need to keep swapping one's arsenal of specs or, as
seems already have become a fashionable trend, letting the reading
glasses slide down one's nose. This is something I see as a
desire to draw attention to one's excellent distance vision. With
the above-mentioned glasses, you would always have the right focus
where you need it.
The lower the threshold for starting to wear glasses the
better (at the age of 40 to 45 years). As regards our health and
the ease of getting used to glasses at least, the very dumbest
attitude is putting it off until it is absolutely unavoidable.
If you happen to be one of those rare people who, when
looking out into the distance, do not need even a slight plus
correction, you could have plus minus zero in the top section, or
a plano glass; the main thing is that the necessary plus lower
section is always there, or if you are myopic and find it easier
to read without glasses, then you should have a similar plano
glass in the lower section. The main thing is that such as people
attending to a lecture need not constantly be disturbed by the
speaker pulling his or her glasses up and down his nose or
swapping them. I cannot help but wonder that, as much as we hear
about the building up and polishing of the images of public
personalities, this essential area seems to have escaped notice.
But the reason for this can to no small degree be attributed to my
own profession: ophthalmologists should play a leading role in
guiding people in this matter. If these people could themselves
see how disturbing this kind of behaviour is and how much it
undermines their credibility, they would certainly hasten to put
the matter to rights. Personally, when I am forced to watch a
speaker who keeps pulling his or her glasses up and down numerous
times, I for one lose my concentration on the actual message.
And how tortuous it is to see speakers who, squinting their
faces, try to cope with their printouts, images etc. despite
their defect. By squinting your eyes and frowning it is possible
to achieve a so-called stenopaic, pinhole, which will get you
through even the smallest print, but what is the price? It most
definitively will not make anyone look younger. A restful
expression and a peaceful countenance are a much more pleasant
sight.
In addition to this aesthetic problem, I cannot stress enough
the great importance appropriate glasses have for the wellbeing of
the whole body and autonomous balance. This theme would deserve a
whole book dedicated to it.
A "manager" waving his glasses about by the temple and
leaning back his chair may think he gives a relaxed and pleasant
impression but – civilised people will not eat their frames!
Turku 6 September 2007
Kaisu Viikari
TO SPECTACLE WEARERS AND EYE PATIENTS
Most eye troubles and particularly headaches, including their
most severe form, migraine, are fundamentally the result of
abnormal refracting power.
The refracting power of the eye depends on the anatomical
shape of the eyeball which is hereditary like all other physical
features. All visual concentration but especially close work
requires a change in the shape of the lens inside the eye, and
this change is made possibly by the ciliary muscle in the eye.
During prolonged effort the ciliary muscle like any other muscle,
gets overstrained and undergoes a spasm of accommodation. The
spasm and impulses transmitted by the spastic muscle trigger off
the headache. In the treatment of spasm of accommodation plus
glasses are always required, or a modification of existing
spectacles in the plus direction. It is in the character of
latent hypermetropia (far-sightedness) that it becomes ever more
manifest as long as a person lives. For this reason, the first
spectacles are often not strong enough. To ensure that the
treatment is effective and brings about the desired result, the
strongest possible lenses should be prescribed at the beginning.
Even in the best cases the glasses usually only correct a fraction
of the true defect, concealed in the background, and only a part
of that which has already been detected in examination. In the
conditions of every day life it is not possible right away to wear
glasses that fully correct the fault. An eye which has for years
behaved in a certain way automatically persists in its error. For
this reason it is necessary to begin with glasses with a smaller
plus value and by stages introduce stronger ones as soon as
possible. The release of the spasm can be accelerated if two
pairs of glasses are used, or bifocal lenses; perhaps even several
pairs of glasses which can be used alternately, the stronger ones
always for close work. This treatment may be followed
irrespective of age.
If a patient is given glasses with which he can at once see
well at a distance and which he makes no complaints about, his
trouble will not be greatly alleviated. In most cases the result
would rather be adverse, because patients suffering from spasm of
accommodation often want minus glasses instead of the correct plus
glasses! Moreover, patients who are given glasses that are not
strong enough find them useless almost at once, and the spectacles
have to be changed at considerable and unnecessary cost. It
should be plain from what has been written above that a patient
being treated for eye troubles must try to adapt himself to a
state of affairs where he sees less well at a distance than he is
accustomed to doing either without glasses at all or with weaker
plus glasses to which he has become accustomed. This phase is of
course unpleasant, but it causes no harm and a cure can only be
effected at the price of such discomfort. To put it in a
nutshell, the more bleary your vision the quicker you will be
cured!
It is important to be aware of the fact that to see well at a
distance is not the same thing as to see perfectly. The glasses
may seem impossible for distant vision, but the patient must first
get used to them when doing close work, when they are easy to wear
and then he must be persuaded gently but firmly to use them all
the time. The patient is gradually helped, by means of close work
to get accustomed to the glasses also for long distance vision.
This will be the sequence of events in every case. It is easier
to get used to stronger plus glasses in daylight and therefore no
opportunity of accommodating oneself to them in daylight should be
missed. During an arduous day’s work, the accommodation tends to
strain. The strongest glasses should therefore be worn first
thing in the morning and for this purpose it is good to keep them
on a bedside table (or under the bed) so that they can be put on
in the morning even before switching on the light. If by the
afternoon the blur is unpleasant, a weaker pair of plus glasses
may be substituted, unless there are signs of a headache.
Night driving is a problem indeed, it being far less easy to
release the accommodation in darkness and the difference between
glasses worn in daylight and those required for night driving may
be as much as a diopter or even more. For this reason it is a
good idea to keep the old glasses handy for the transition from
daylight to darkness.
It is by no means unusual that to begin with, on the first
day or even for several weeks, when the new or stronger glasses
are worn, the patient suffers from a headache or even a severe
attack of migraine. This results from relaxation of the ciliary
muscle followed by physiological changes in the organism. It does
not mean that the glasses are unsuitable and there is no need for
concern.
If the patient has several pairs of glasses of different
strengths, when he gets a headache or an attack of migraine, he
must immediately put on the strongest possible plus glasses or
even two pairs, one on top of the other, just relax, look around
and try to bear it even though everything looks blurred. There is
no danger to the eyes and no one will get hurt. On the contrary
it is the simplest and best way of releasing the spasm of
accommodation which is causing the headache.
If the patient can afford it the best way of warding off
headaches is to have an extra pair of glasses which are especially
strong, perhaps 2-4 dioptres stronger than those usually worn.
The cheapest form of bifocal spectacles is that in which
there are only half-lenses and they can always be replaced by full
lenses in which the vacant half is ± 0; the only difference is one
of price. Half-lenses are often necessary when the patient is
being treated for spasm of accommodation.
Case 1. The patient is able to wear plus glasses for close
work but finds the distant blur utterly unbearable. By removing
the top half of the lens the patient can be enabled to see as well
in the distance as before and in this way one can continue with
the necessary treatment. In order to ensure that the glasses are
effective, the empty upper half must be as small as possible so
that the patient is obliged to do close work through the lower,
plus half otherwise the glasses quite fail in their effect.
Case 2. The patient has become pseudo-myopic due to a severe
spasm of accommodation; in order to release the spasm the same
principle as above must be observed, but this time it is the lower
half of the lens that is removed. (This is possible with a
certain degree of pseudomyopia ; for those who had very strong
minus glasses it is necessary to use bifocal lenses., in which the
lower half has a smaller minus value.) Such a person can manage
close work easily without glasses and in doing so is giving
himself the best possible treatment. The avoiding of close work
through minus glasses results in relaxation of the spasm of
accommodation. In this case, the lower port must have the highest
possible limit so that it is impossible to do close work through
the minus half. Otherwise the spectacles are more or less
useless. Depending on the design of the frame, this half-lens can
be extremely narrow.
Spectacles, which in any case are the alpha and omega of eye
treatment, are the starting point, from which one can go on to
possible further treatment.
Patients are welcome to telephone the oculist when in
difficulties and to seek encouragement, but not in order to
explain that their distant vision is blurred and that the
spectacles should be changed. If instructions have been followed
and there has been no improvement it is of course necessary to
consult the oculist.
The above instructions are appropriate for one and all, but
those who see well in all circumstances, do not suffer from
headaches and have no evident eye trouble will find it hard to see
their significance. On the other hand, when treating complicated
cases all the above points are extremely important.
I wish all my patients to peruse this leaflet before getting
their glasses, so that they may be prepared for the difficulties
ahead.
Turku, February 25, 1974
Kaisu Viikari Specialist in eye disease Dr. of Medicine and
Surgery
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Feedback:
Contents:
Review of Tetralogia by Aune Adel, 1974
Suomen Kuvalehti magazine article 'Onko pluslaseista apua',
25th of April, 1974
Turun Sanomat article 'Jokainen tarvitsee laseja jonakin
aikana elämässään' , June 13th 1973
Review of Tetralogia by Ophthalmologist Aune Adel:
Translated from Suomen Lääkärilehti (Finn Med J)6/74,
Tetralogia -nakemys oftalmologiasta - Lataa suomenkielinen pdf
Tetralogy -A view on ophthalmology
This book is intended to ophthalmologists, the author herself
being an ophthalmologist. It should, however, interest
specialists in other fields since an enterily new approach to
ophthalmolgy is presented. This study breaks the traditional
narrow boundaries of ophthalmolgy penetrating into the most
central fields of medicine as a whole.
This book is not a doctrinal! work based on theoretical
speculation nor is it a product of an unusual imaginative power.
On the contrary, it is the anatomy of the work at a private
practice during a period of years. The results of this work,
however, did not fully satisfy the practitioner. Instead they
seemed continuously to leave the door open to criticism leading to
the search for new ways and methods. The ideas of the book, it
seems to me, started with an intense questioning. Why does this
particular patient show this kind of a refrative error, an
anisometropia, a heterophoria, an increased intraocular tension
etc. When the answer finally emerged the symptomatic treatment
was resolutely given up. Thus "the exact correction" of a
refractive error, the operative measure, the hastily written
prescription for lowering the tension were abandoned. With the
etiological factor found, the recognized academic measures no
longer proved rational. Logical thinking combined with longterm
clinical observation led to new methods and to therapy in
conditions which, until now, have been considered beyond
treatment.
The central theme of "Tetralogy" is the refraction of the
eye, its determination, variations and its effect on the organism
as a whole. Contrary to the textbooks, which divide refractive
errors into three groups, the author believes that there is only
one refractive error, hyperopia, together with its various grades.
Thus myopia and astigmatism are distortions, artefacts, due to the
corrective mechanisms of the eye, the accommodation performed by
the ciliary muscle with its autonomous innervation. Under
continuous strain and a presumable overexitability the result may
end not only in pseudo-myopia and pseudo-astigmatism but at same
time in overactivation, a possible sensitization of the entire
autonomous nervous system. This is manifested in clinical
symptoms as headaches, migraine, epilepic attacks, attacks of
pseudo-angina pectoris, intestinal spasms, to mention only a few.
Ocular symptoms include accommodative spasm, often combined with
pseudo-myopia and pseudo-astigmatism, anisometropia, nystagmus,
conjunctival irritations, photophobia, even detachments and
degenerative conditions of the retina. Treatment is always solved
once the etiology is found.
Thus refractive error should not necessarily be corrected by
prescribing lenses giving the best visual acuity at distance but
by correcting the latent hyperopia as thoroughly as possible.
Seemingly paradoxically, plus lenses are prescribed for
pseudo-myopia the idea being, of course, relaxation of the
accommodative spasm. The hazards of minus lenses are clearly
brought out in the clinical material of the book.
Further the book shows clearly that applying optics as such
into a living organism, the eye, may have a clearly damaging
effect. of the refractive error at the moment of an examination
is a relatively simple procedure by present methods. Thus
correction of a refractive error according to the retinoscopy or
refractometer findings and prescription of lenses giving the best
visual aquity at five to six meters is easily performed. In
practice this has led to certain schematism and nonchalans.
Prescrpition of lenses come easily (touring ophthalmolgists
prescriptions by opticians). On the other hand, a procedure that
consists in a nearly mechanical mesuring, may easily become
tedious. Many ophthalmologists therefore consider refraction the
least interesting part of their field. It has even become a
negation, it may be omitted entirely or left in the hands of the
least experinced practitioner or of an optician. The results may
be disastrous.
Adoption of the ideas ov Tetrlogy may not come easily. For
an ophthalmologist it means a change of attituide and abandoning
hypothesis already crystallized to axioms. But once adopted they
offer the possibility of really helping the patient. They not
only give significans to determination of refraction so often
considered trivial but at the same time open up new dimensions
invisible to both the retinoscope and the ophthalmoscope -a fact
for which an ophtalmologist cannot be but grateful. The author
has not by customary scientific methods attempted to prove her
achievements. Every practising ophthalmologist, however, will be
able to find the observations true provided he has the desire to
"see wood for trees". Tetralogy, in my opinion, is more than a
more scientific work. It breaths the joy of a basic perception
having its full applicability in practice. This joy the author
wants to share with her colleagues. What importance Tetralogy
will have on medicine as a whole can so far only be envisaged.
Aune Adel Ophthalmologist
Articles:
Suomen Kuvalehti 25th of April, 1974
(download pdf 2.3 MB 8 pages)
Turun Sanomat June 13th 1973
(download pdf 2.9 MB 1 page)
When journalist Vieno Räty from Turun Sanomat interviewed me
in May 1973 about Tetralogia, she said that reading the book all
the time had made her think about Jonathan Livingston Seagull. I
immediately got hold of this book, and I have collected here a
number of thoughts that describe the struggle needed for my
thoughts to break through, too.
Most gulls don't bother to learn more than the simplest facts
of flight.
I don't mind being bone and feathers, Mum. … I just want to
know.
Of course, it is impossible to love hatred and meanness.
You just have to go on looking for yourself.
I want to share with others what I have found out myself.
When they hear about it, Jonathan thought, my revolutionary
achievement, they will be wild with joy. How much more there now
is to living … there's reason to live.
(((((((((((((((((((((((((((((((((((((
About me:
CV
Born 25th of February 1922
In summer 1938 2 months in school girl (pension) family
boarding in Germany, Ost-Preussen, Angerburg
Student under war time 1940, the first “pardon” students,
without examinations. Under the war time 1939-1944 as
anti-aircraft surveillance control and sanitary Lotta in German
military-surgical hospital and as a medicine candidate-physician
in military hospital.
M.L, Licentiate in Medicine at Helsinki University 1948
MD, PhD at Helsinki University 1955
Specialist in Ophthalmology at Helsinki University 1956
Private practitioner in Turku, Finland 1956-1991
My warmest thanks to architect Vesa Loikas who´s skills and
interest have made these pages possible.
*******************
Data Copied from Internet:
http://www.kaisuviikari.com/about_me.htm
Enjoy,
Otis Brown